Authors' objectives:

The aim of this report was to assess current recommendations on androgen deprivation treatment for the management of prostate cancer.

Authors' results and conclusions: Fourteen reports or recommendations (including clinical practice guidelines, etc) were identified: - Localized disease (organ confined): the strategies of choice for the treatment of these stages are those which have curative intent (surgery or radiotherapy). In this sense, the most recently published guidelines recommend the use of androgen deprivation as adjuvant therapy to radiotherapy. Although the use of palliative hormonal therapy for these stages is not currently recommended, some guidelines consider it could be an option for some very well selected symptomatic patients (with very poor prognosis and who can not undergo curative treatments). - Locally advanced disease (invasion of nearby organs): the different recommendations consider palliative androgen deprivation as a valid initial treatment option for some patients (symptomatic patients with more advanced disease or shorter life expectancy). For patients with less advance stages, who will undergo radiotherapy with curative intent (as an alternative to surgery), the different guidelines agree on the use of concomitant hormonal therapy (adjuvant treatment). - Disseminated disease (metastases): orchiectomy and luteinizing hormone-releasing hormone (LHRH) agonists are considered the treatment of choice by all guidelines. The use of diethylstilbestrol or cyproterone is not recommended because of its side effects. Antiandrogens are generally considered as second line treatments. - Recurrent disease after curative intent: according to the documents that analyzed the subject, hormonal therapy would be the treatment of choice for distant recurrences (metastases). As regards local recurrences, these could be treated with radical rescue measures (prostatectomy or radiotherapy), with the eventual late use of androgen deprivation. According to one of the guidelines, the use of hormonal therapy concomitant to rescue radiotherapy could be a valid option. - Clinical trials: Fourteen recently published clinical trials were identified. Out of these, 4 found that the use of hormonal therapy as adjuvant treatment to radiotherapy for patients with locally advanced disease is beneficial. In localized disease, the use of adjuvant hormonal therapy yielded dissimilar results.

Authors' recommendations: There is great consensus on recommending hormonal therapy as palliative treatment for patients with disseminated disease, or symptomatic patients with localized or locally advanced disease if they meet the following criteria: older than 80 years old; less than 10 years of life expectancy; or contraindication to receive surgical treatment or radiotherapy (that is to say, when curative treatment is not an option). As regards its use as adjuvant therapy, most guidelines recommend it for patients with locally advanced disease who will undergo radiotherapy (with curative intent) as an option to surgery. The most recently published guidelines extend the recommendation to earlier stages (localized disease), although the evidence found is still controversial. As regards treatment itself, both bilateral orchiectomy and LHRH analogs are generally known for having the same therapeutic efficacy. In general, it is considered that monotherapy with antiandrogens should be used only as second line therapy. Combination therapy (LHRH agonist plus antiandrogens) should not be routinely indicated.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)